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Background: A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana., Methods: The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews., Results: The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484)., Conclusions: The electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability.

Introduction: Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories. Methods: Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. Results: We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access. Conclusion: Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs. [ABSTRACT FROM AUTHOR]

Background: The MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources., Methods: MODEM starts with a systematic mapping of the literature on effective and (potentially) cost-effective interventions in dementia care. Those findings, as well as data from a cohort, will then be used to model the quality of life and cost impacts of making these evidence-based interventions more widely available in England over the period from now to 2040. Modelling will use a suite of models, combining microsimulation and macrosimulation methods, modelling the costs and outcomes of care, both for an individual over the life-course from the point of dementia diagnosis, and for individuals and England as a whole in a particular year. Project outputs will include an online Dementia Evidence Toolkit, making evidence summaries and a literature database available free to anyone, papers in academic journals and other written outputs, and a MODEM Legacy Model, which will enable local commissioners of services to apply the model to their own populations., Discussion: Modelling the effects of evidence-based cost-effective interventions and making this information widely available has the potential to improve the health and quality of life both of people with dementia and their carers, while ensuring that resources are used efficiently.

Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between 'intervention' and 'implementation', yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between., Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively., Conclusion: Semantics provide opportunities for improved precision in depicting what is 'intervention' and what is 'implementation' in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.

Background Historically, the paper hand-held record (PHR) has been used for sharing information between hospital clinicians, general practitioners and pregnant women in a maternity sharedcare environment. Recently in alignment with a National e-health agenda, an electronic health record (EHR) was introduced at an Australian tertiary maternity service to replace the PHR for collection and transfer of data. The aim of this study was to examine and compare the completeness of clinical data collected in a PHR and an EHR. Methods We undertook a comparative cohort design study to determine differences in completeness between data collected from maternity records in two phases. Phase 1 data were collected from the PHR and Phase 2 data from the EHR. Records were examined and compared for completeness of best practice variables collected, informed by local and national maternity guidelines. The primary outcome was the presence of best practice variables identified from the guidelines and the secondary outcomes were the differences in individual variables between the records. Results Ninety-four percent of paper medical charts were available by audit in Phase 1 and 100% of records from an obstetric database in Phase 2. No PHR or EHR had a complete dataset of best practice variables. The variables with significant improvement in completeness of data documented in the EHR, compared with the PHR, were urine culture, glucose tolerance test (GTT), nuchal screening, morphology scans, folic acid advice, tobacco smoking, illicit drug assessment and domestic violence assessment (p = 0.001). Additionally the documentation of immunisations (pertussis, hepatitis B, varicella, fluvax) were markedly improved in the EHR (p = 0.001). The variables of blood pressure, proteinuria, blood group, antibody, rubella and syphilis status, showed no significant differences in completeness of recording. Conclusion This is the first paper to report on the comparison of clinical data collected on a PHR and EHR in a maternity shared-care setting. The use of an EHR demonstrated statistically significant improvements to the adherence of collected best practice variables. Additionally, the data in an EHR were more available to relevant clinical staff with the appropriate log-in and more easily retrieved than from the PHR. This study contributes to an under-researched area of determining data quality collected in patient records. Having access to up to date antenatal information that can be shared between maternity health care providers and pregnant women, is fundamental to improving communication between health care providers and patient safety. [ABSTRACT FROM AUTHOR]

Background: There is an urgent need for the development of simple communication tools that convey the strengths, assets, and healthcare needs of people living with dementia. A Healthcare Passport may improve communication with range of health and social support services, enhancing quality and continuity of care, and to permit a consideration of the challenges and how these might be managed effectively and compassionately. This study aims to evaluate the acceptability and use of this type of intervention for people living with dementia and their carers., Methods/design: This is a qualitative longitudinal study informed by a critical realist review. The participants will be individuals identified as having mild-moderate dementia and informal carers. The in-depth interviews will occur at three points over the course of 18 months as they use the passport. This will be supplemented by analysis of the content of the passports and information from health and social care providers on the daily practicalities of using the passport in a range of healthcare settings., Discussion: By using a critical realist review and a qualitative, longitudinal approach, the study allows for the assessment of a complex intervention in a manner which goes beyond evaluating the basic efficacy of the passport, but looking more deeply at how it worked, for whom, and in what context. It has the potential to develop new data on how interventions improve communication across a range of service providers, while encouraging health and social care professionals to respect and encourage the development of self-management and retention of personhood throughout the progression of life-limiting illnesses.

Background: The recent crises of bushfires, floods, and the COVID-19 pandemic on the southeast coast of Australia were unprecedented in their extent and intensity. Few studies have investigated responses to cumulative disasters in First Nations communities, despite acknowledgement that these crises disproportionately impact First Nations people. This study was conducted by Aboriginal and non-Aboriginal researchers in partnership with Waminda, South Coast Women's Health and Wellbeing Aboriginal Corporation, an Aboriginal Community Controlled Health Organisation (ACCHO). It investigated the collective experiences of people affected by cumulative disasters to identify the practices that support healing, and recovery for Aboriginal communities. The study addresses a knowledge gap of how Waminda, designs, manages and delivers responses to address complex health and social issues in the context of cumulative disasters. Methods: Underpinned by practice theory this study employed Indigenous-informed, narrative inquiry. Culturally-appropriate, multiple interpretive methods were used to collect data including: observations; yarns with Aboriginal community members, yarns with Waminda practitioners, management and board members; interviews-to-the-double, visual images and documentation. The data were collated and analysed using the phases of reflexive thematic analysis. Results: The paper articulates a suite of culturally safe and place-based practices that enhance social, emotional and spiritual well-being following cumulative disasters. These practice bundles include: adopting a Country-centred conception of local communities; being community-led; viewing care as a collective, relational, sociomaterial accomplishment and having fluid boundaries. These practice bundles 'hang together' through organising practices including the Waminda Model of Care, staff wellbeing framework and emergency management plan which orient action and manage risks. The paper demonstrates the need for disaster responses to be community-led and culturally situated. ACCHOs are shown to play a crucial role, and their local responses to immediate community needs are grounded in contextual knowledge and use existing resources rather than relying on mainstream system-wide interventions. Conclusions: The paper suggests crafting responses that focus on assisting communities (re)gain their sense of belonging, hope for the future, control over their lives and their capacities to care for and to be cared for by Country, are key to both enhancing healing, health and well-being and harnessing the strengths of communities. [ABSTRACT FROM AUTHOR]

Background: Medical emergencies are the leading cause of high mortality and morbidity rates in rural areas of higher and lower-income countries than in urban areas. Medical emergency readiness is healthcare providers' knowledge, skills, and confidence to meet patients' emergency needs. Rural healthcare professionals' medical emergency readiness is imperative to prevent or reduce casualties due to medical emergencies. Evidence shows that rural healthcare providers' emergency readiness needs enhancement. Education and training are the effective ways to improve them. However, there has yet to be a scoping review to understand the efficacy of educational intervention regarding rural healthcare providers' medical emergency readiness. Objectives: This scoping review aimed to identify and understand the effectiveness of educational interventions in improving rural healthcare providers' medical emergency readiness globally. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were used to select the papers for this scoping review. This scoping review was conducted using MEDLINE, CINHAL, SCOPUS, PUBMED and OVID databases. The Population, Intervention, Comparison and Outcome [PICO] strategies were used to select the papers from the database. The selected papers were limited to English, peer-reviewed journals and published from 2013 to 2023. A total of 536 studies were retrieved, and ten studies that met the selection criteria were included in the review. Three reviewers appraised the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. A descriptive method was used to analyse the data. Results: From the identified 536 papers, the ten papers which met the PICO strategies were selected for the scoping review. Results show that rural healthcare providers' emergency readiness remains the same globally. All interventions were effective in enhancing rural health care providers' medical emergency readiness, though the interventions were implemented at various durations of time and in different foci of medical emergencies. Results showed that the low-fidelity simulated manikins were the most cost-effective intervention to train rural healthcare professionals globally. Conclusion: The review concluded that rural healthcare providers' medical emergency readiness improved after the interventions. However, the limitations associated with the studies caution readers to read the results sensibly. Moreover, future research should focus on understanding the interventions' behavioural outcomes, especially among rural healthcare providers in low to middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Specialized drug shops (SDSs) are popular in Sub-Saharan Africa because they provide convenient access to medicines. There is increasing interest in how policymakers can work with them, but little knowledge on how their operation relates to regulatory frameworks. This study sought to describe characteristics and predictors of regulatory practices among SDSs in Kenya., Methods: The regulatory framework governing the Kenya pharmaceutical sector was mapped, and a list of regulations selected for inclusion in a survey questionnaire. An SDS census was conducted, and survey data collected from 213 SDSs from two districts in Western Kenya., Results: The majority of SDSs did not comply with regulations, with only 12% having a refrigerator and 22% having a separate dispensing area for instance. Additionally, less than half had at least one staff with pharmacy qualification (46%), with less than a third of all interviewed operators knowing the name of the law governing pharmacy.Regulatory infringement was more common among SDSs in rural locations; those that did not have staff with pharmacy qualifications; and those whose operator did not know the name of the pharmacy law. Compliance was not significantly associated with the frequency of inspections, with over 80% of both rural and urban SDSs reporting an inspection in the past year., Conclusion: While compliance was low overall, it was particularly poor among SDSs operating in rural locations, and those that did not have staff with pharmacy qualification. This suggested the need for policy to introduce levels of practice in recognition of the variations in resource availability. Under such a system, rural SDSs operating in low-resource setting, and selling a limited range of medicines, may be exempted from certain regulatory requirements, as long as their scope of practice is limited to certain essential services only. Future research should also explore why regulatory compliance is poor despite regular inspections.

Background: As coproduction in public services increases, understanding the role of leadership in this context is essential to the tasks of establishing relational partnerships and addressing power differentials among groups. The aims of this review are to explore models of coproduction leadership and the processes involved in leading coproduction as well as, based on that exploration, to develop a guiding framework for coproduction practices. Methods: A systematic review that synthesizes the evidence reported by 73 papers related to coproduction of health and welfare. Results: Despite the fact that models of coleadership and collective leadership exhibit a better fit with the relational character of coproduction, the majority of the articles included in this review employed a leader-centric underlying theory. The practice of coproduction leadership is a complex activity pertaining to interactions among people, encompassing nine essential practices: initiating, power-sharing, training, supporting, establishing trust, communicating, networking, orchestration, and implementation. Conclusions: This paper proposes a novel framework for coproduction leadership practices based on a systematic review of the literature and a set of reflective questions. This framework aims to help coproduction leaders and participants understand the complexity, diversity, and flexibility of coproduction leadership and to challenge and enhance their capacity to collaborate effectively. [ABSTRACT FROM AUTHOR]

Introduction: This paper presents a structured review of the use of crisis management, specifically examining the frameworks of surge capacity, resilience, and dynamic capabilities in healthcare organizations. Thereafter, a novel deductive method based on the framework of dynamic capabilities is developed and applied to investigate crisis management in two hospital cases during the COVID-19 pandemic. Background: The COVID-19 pandemic distinguishes itself from many other disasters due to its global spread, uncertainty, and prolonged duration. While crisis management in healthcare has often been explained using the surge capacity framework, the need for adaptability in an unfamiliar setting and different information flow makes the dynamic capabilities framework more useful. Methods: The dynamic capabilities framework's microfoundations as categories is utilized in this paper for a deductive analysis of crisis management during the COVID-19 pandemic in a multiple case study involving two Swedish public hospitals. A novel method, incorporating both dynamic and static capabilities across multiple organizational levels, is developed and explored. Results: The case study results reveal the utilization of all dynamic capabilities with an increased emphasis at lower organizational levels and a higher prevalence of static capabilities at the regional level. In Case A, lower-level managers perceived the hospital manager as brave, supporting sensing, seizing, and transformation at the department level. However, due to information gaps, sensing did not reach regional crisis management, reducing their power. In Case B, with contingency plans not initiated, the hospital faced a lack of management and formed a department manager group for patient care. Seizing was robust at the department level, but regional levels struggled with decisions on crisis versus normal management. The novel method effectively visualizes differences between organizational levels and cases, shedding light on the extent of cooperation or lack thereof within the organization. Conclusion: The researchers conclude that crisis management in a pandemic, benefits from distributed management, attributed to higher dynamic capabilities at lower organizational levels. A pandemic contingency plan should differ from a plan for accidents, supporting the development of routines for the new situation and continuous improvement. The Dynamic Capabilities framework proved successful for exploration in this context. [ABSTRACT FROM AUTHOR]

Background: Universal health visiting has been a cornerstone of preventative healthcare for children in the United Kingdom (UK) for over 100 years. In 2016, Scotland introduced a new Universal Health Visiting Pathway (UHVP), involving a greater number of contacts with a particular emphasis on the first year, visits within the home setting, and rigorous developmental assessment conducted by a qualified Health Visitor. To evaluate the UHVP, an outcome indicator framework was developed using routine administrative data. This paper sets out the development of these indicators. Methods: A logic model was produced with stakeholders to define the group of outcomes, before further refining and aligning of the measures through discussions with stakeholders and inspection of data. Power calculations were carried out and initial data described for the chosen indicators. Results: Eighteen indicators were selected across eight outcome areas: parental smoking, breastfeeding, immunisations, dental health, developmental concerns, obesity, accidents and injuries, and child protection interventions. Data quality was mixed. Coverage of reviews was high; over 90% of children received key reviews. Individual item completion was more variable: 92.2% had breastfeeding data at 6–8 weeks, whilst 63.2% had BMI recorded at 27–30 months. Prevalence also varied greatly, from 1.3% of children's names being on the Child Protection register for over six months by age three, to 93.6% having received all immunisations by age two. Conclusions: Home visiting services play a key role in ensuring children and families have the right support to enable the best start in life. As these programmes evolve, it is crucial to understand whether changes lead to improvements in child outcomes. This paper describes a set of indicators using routinely-collected data, lessening additional burden on participants, and reducing response bias which may be apparent in other forms of evaluation. Further research is needed to explore the transferability of this indicator framework to other settings. [ABSTRACT FROM AUTHOR]

Purpose: Several studies have been carried out on defensive medicine, but research from the managerial viewpoint is still scarce. Therefore, the aim of the present study is to conduct a literature review to better understand defensive medicine from a managerial perspective. Design/methodology/approach: A literature review was conducted of studies focusing on the organisational (meso) level of healthcare providers and managerial practices. A final sample of 28 studies was processed. Findings: Defensive medicine has mainly been studied in the USA, and scholars have principally used quantitative surveys. High-risk specialities have been a critical field of investigation, and a large portion of the papers are published in journals that cover medicine, health policy, education and law fields. The analysis showed that operations and the organisation of staffing were the most discussed managerial practices. No study considered planning and budgeting aspects. Originality/value: The review confirmed that the managerial aspect of defensive medicine has not been fully addressed. Stimulated by this gap, this study analyses the managerial background of the defensive medicine phenomenon and shows which managerial practices have been most analysed. This paper also contributes to developing the literature on defensive medicine from the managerial side. Areas for future research include qualitative studies to investigate the behaviour of managers of healthcare companies to give a different perspective on defensive medicine and organisations' decision-making. Research limitations/implications: Some important publications might have been missed in this work because of the choice of only two databases. A further limit could be imposed by the use of the English language as an inclusion criterion. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper is to develop a maturity model (MM) for demand and capacity management (DCM) processes in healthcare settings, which yields opportunities for organisations to diagnose their planning and production processes, identify gaps in their operations and evaluate improvements. Methods: Informed by existing DCM maturity frameworks, qualitative research methods were used to develop the MM, including major adaptations and additions in the healthcare context. The development phases for maturity assessment models proposed by de Bruin et al. were used as a structure for the research procedure: (1) determination of scope, (2) design of a conceptual MM, (3) adjustments and population of the MM to the specific context and (4) test of construct and validity. An embedded single-case study was conducted for the latter two - four units divided into two hospitals with specialised outpatient care introducing a structured DCM work process. Data was collected through interviews, observations, field notes and document studies. Thematic analyses were carried out using a systematic combination of deductive and inductive analyses - an abductive approach - with the MM progressing with incremental modifications. Results: We propose a five-stage MM with six categories for assessing healthcare DCM determined in relation to patient flows (vertical alignment) and organisational levels (horizontal alignment). Our application of this model to our specific case indicates its usefulness in evaluating DCM maturity. Specifically, it reveals that transitioning from service activities to a holistic focus on patient flows during the planning process is necessary to progress to more advanced stages. Conclusion: In this paper, a model for assessing healthcare DCM and for creating roadmaps for improvements towards more mature levels has been developed and tested. To refine and finalise the model, we propose further evaluations of its usefulness and validity by including more contextual differences in patient demand and supply prerequisites. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) guidelines established in 1992 to decrease preventable under-five child morbidity and mortality, was adopted by Nigeria in 1997. Over 20 years later, while under-five child mortality remains high, less than 25% of first level facilities have trained 60% of community health workers (CHW) who care for sick children with IMCI. This study investigated the impact in CHWs overall adherence to IMCI guidelines, particularly for critical danger signs, as well as usability and feasible following the implementation of THINKMD's IMCI-based digital clinical decision support (CDS) platform. Methods: Adherence to IMCI guidelines was assessed by observational and digital data acquisition of key IMCI clinical data points by 28 CHWs, prior, during, and post CDS platform implementation. Change in IMCI adherence was determined for individual CHW and for the cohort by analyzing the number of IMCI data points acquired by each CHW per clinical evaluation. Consistency of adherence was also calculated by averaging the percentage of total evaluations each data point was observed. Usability and acceptability surveys were administered following use of the CDS platform. Results: THINKMD CDS platform implementation notably enhanced the CHWs' ability to capture key IMCI clinical data elements. We observed a significant increase in the mean percentage of data points captured between the baseline period and during the CDS technology implementation (T-test, t = -31.399, p < 0.016, Holm-Bonferroni correction, two-sided), with the mean values going from 30.7% to 72.4%. Notably, even after the completion of the technology implementation phase, the mean percentage of IMCI elements captured by CHWs remained significantly elevated compared to the baseline, with a 26.72 percentage point increase (from 30.7% to 57.4%, T-test, t = -15.779, p < 0.05, Holm-Bonferroni correction, two-sided). Usability and feasibility of the platform was high. CHWs reported that the CDS platform was easy to learn and use (93%) and enabled them to identify sick children (100%). Conclusion: These results demonstrate that utilization of a digital clinical decision support tool such as THINKMD's IMCI based CDS platform can significantly increase CHW adherence to IMCI guidelines over paper-based utilization, increase clinical quality and capacity, and improve identification of key danger signs for under-five children while being highly accepted and adopted. [ABSTRACT FROM AUTHOR]

Background: Chief Executive Officer's (CEO) are integral leaders of health care organisation. Over the last two decades in United States (US) hospitals, it has been noted that CEO turnover rates are increasing, and it was reported that the CEO turnover rates have augmented from 14% in 2008 to 18% in 2017 in the private sector. In Australia, it was discovered that during two years, 41 executives had 18 distinct positions. It has been highlighted that the increasing CEO turnover is a major issue for Australian and international health care organisations. Some of the negative consequences of CEO turnover include organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care. Objective: Our scoping review aimed to map and summarise the evidence associated with CEO turnovers in both health and non-health setting, and answer the following questions: 1. What are the reasons for CEO departure?, 2. What are the strategies to minimise CEO turnover? Results: A protocol explaining the objectives, inclusion criteria and methods for this scoping review were specified in advance and published. This scoping review included 17 studies (13 health and 4 non-health setting) published over a 31-year period that investigated and described the increasing CEO turnover rates. All 17 studies identified causes of CEO turnover along with certain studies identifying facilitators of CEO retention. We classified CEO's departure reasons into three major themes: organizational, performance, and personal. Organisational factors include CEO departures due to issues within the organisation, performance factors include issues with CEO's work and personal factors captures personal reasons for CEO's leaving their job. Conclusion: CEOs are under immense pressure to deliver good results and drive growth while satisfying the interests of internal and external stakeholders. There are various reasons for CEO's departure however the most common factor identified is organisational. Contribution of paper statement: What is already known Causes and consequences of CEO turnover in both health and non-health settings. What this paper adds Three main factors associated with CEO turnover such as organisational, performance and personal factors. [ABSTRACT FROM AUTHOR]

Background: Existing evidence suggests that clinician and organisation engagement in research can improve healthcare performance. With the increase in allied health professional (AHP) research activity, it is imperative for healthcare organisations, clinicians, managers, and leaders to understand research engagement specifically within allied health fields. This systematic review aims to examine the value of research engagement by allied health professionals and organisations on healthcare performance. Methods: This systematic review had a two-stage search strategy. Firstly, the papers from a previous systematic review examining the effect of research engagement in healthcare were screened to identify papers published pre-2012. Secondly, a multi-database search was used to conduct a re-focused update of the previous review, focusing specifically on allied health to identify publications from 2012–2021. Studies which examined the value of allied health research engagement on healthcare performance were included. All stages of the review were conducted by two reviewers independently. Each study was assessed using the appropriate Joanna Briggs Institute critical appraisal tool. A narrative synthesis was completed to analyse the similarities and differences between and within the different study types. Results: Twenty-two studies were included, comprising of mixed research designs, of which six were ranked as high importance. The findings indicated that AHP research engagement appears related to positive findings in improvements to processes of care. The review also identified the most common mechanisms which may link research engagement with these improvements. Discussion: This landmark systematic review and narrative synthesis suggests value in AHP research engagement in terms of both processes of care and more tentatively, of healthcare outcomes. While caution is required because of the lack of robust research studies, overall the findings support the agenda for growing AHP research. Recommendations are made to improve transparent reporting of AHP research engagement and to contribute essential evidence of the value of AHP research engagement. Trial registration: This systematic review protocol was registered with the international prospective register of systematic reviews, PROSPERO (registration number CRD42021253461). [ABSTRACT FROM AUTHOR]

Background: Scandinavian countries are internationally recognised for leading the way in older adult care and in digitally transforming healthcare. Dignity has become a central value in care for older adults in all three Scandinavian countries. Investigating documents about digitalisation in these countries can offer insights into how the dignity of older adults is impacted by digitally transforming healthcare. This study aims to provide knowledge about digital strategies and eHealth policies concerning older adults' dignity in three Scandinavian countries: Norway, Sweden and Denmark. Methods: National-level documents by the Norwegian Directorate of eHealth, the Norwegian Directorate of Health, the Swedish Ministry of Health and Social Affairs and the Danish Ministry of Health concerning older adults were used as data sources. In addition, a systematic search of databases, informed by the Joanna Briggs Institute framework for systematic reviews of text and opinion papers, was undertaken to find relevant papers. All extracts concerning national digital strategies or innovative eHealth policies were deductively coded. Thereafter, extracts concerning older adults were inductively coded using a thematic analytic approach. Results: A total of 26 sources satisfied the inclusion criteria, 14 governmental papers and 12 other papers. The three countries' national digital strategies focused on access to digital technologies and continuous learning for digital skills. The included papers describing national eHealth policies underlined the importance of placing the patient at the centre of healthcare and how digital systems can increase feelings of safety. Both types of documents concerned access to data, digital device security and the human dimension of care. Conclusion: The findings present evidence on Scandinavian countries' national digital strategies and innovative eHealth policies concerning older adults' dignity. The documents describe a lack of digital competence among older adults, resulting disengagement may put their well-being and human dignity at risk. Findings also underline the importance of security and at the same time the human dimension of care: Use of new digital systems must be meaningfully integrated into digital strategies and eHealth policies. All three Scandinavian countries strategies and policies underline the importance of equal access to healthcare services, as thus they promote a stance of dignified care. [ABSTRACT FROM AUTHOR]

Background: Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort. Methods: A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team. Results: Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain. Conclusions: The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys. [ABSTRACT FROM AUTHOR]

Background: Public health emergencies are characterized by uncertainty, rapid transmission, a large number of cases, a high rate of critical illness, and a high case fatality rate. The intensive care unit (ICU) is the "last line of defense" for saving lives. And ICU resources play a critical role in the treatment of critical illness and combating public health emergencies. Objective: This study estimates the demand for ICU healthcare resources based on an accurate prediction of the surge in the number of critically ill patients in the short term. The aim is to provide hospitals with a basis for scientific decision-making, to improve rescue efficiency, and to avoid excessive costs due to overly large resource reserves. Methods: A demand forecasting method for ICU healthcare resources is proposed based on the number of current confirmed cases. The number of current confirmed cases is estimated using a bilateral long-short-term memory and genetic algorithm support vector regression (BILSTM-GASVR) combined prediction model. Based on this, this paper constructs demand forecasting models for ICU healthcare workers and healthcare material resources to more accurately understand the patterns of changes in the demand for ICU healthcare resources and more precisely meet the treatment needs of critically ill patients. Results: Data on the number of COVID-19-infected cases in Shanghai between January 20, 2020, and September 24, 2022, is used to perform a numerical example analysis. Compared to individual prediction models (GASVR, LSTM, BILSTM and Informer), the combined prediction model BILSTM-GASVR produced results that are closer to the real values. The demand forecasting results for ICU healthcare resources showed that the first (ICU human resources) and third (medical equipment resources) categories did not require replenishment during the early stages but experienced a lag in replenishment when shortages occurred during the peak period. The second category (drug resources) is consumed rapidly in the early stages and required earlier replenishment, but replenishment is timelier compared to the first and third categories. However, replenishment is needed throughout the course of the epidemic. Conclusion: The first category of resources (human resources) requires long-term planning and the deployment of emergency expansion measures. The second category of resources (drugs) is suitable for the combination of dynamic physical reserves in healthcare institutions with the production capacity reserves of corporations. The third category of resources (medical equipment) is more dependent on the physical reserves in healthcare institutions, but care must be taken to strike a balance between normalcy and emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Patient feedback system (PFS) forms an important entry point for the medical personnel and healthcare administrators to identify healthcare service delivery gaps and develop responsive interventions. This may foster patient trust consequently increasing healthcare-seeking, engagement in decision, continuity, and satisfaction. However, research on the PFS in rural primary healthcare settings appears limited. Objective: The paper examines the perceived role and effectiveness of PFS in improving therapeutic relationships building on the recent research on patient-provider relationships in rural Tanzania. Methods: The paper examines the findings of qualitative descriptive research conducted in the Shinyanga Region which employed a human-centred design (HCD) approach to co-create an intervention package for improving nurse-client relationships between January and September 2022. The study used semi-structured interviews in Swahili to first explore drivers of poor provider-patient relationships with purposefully selected providers, patients, and administrators. The findings guided the co-designing of an intervention package in subsequent HCD steps. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes using a deductive thematic analysis approach. Results: PFS emerged as one of the key themes in the deductive analysis when examining factors shaping provider–client relationships. The PFS theme was characterized by three major subthemes, which included perceived benefits, availability and accessibility, and perceived effectiveness. The perceived benefits of PFS cited by most participants included: reducing patients' confusion around the complaints process, promoting patients' positivity towards providers and hospitals, and reducing tensions between patients and providers. Suggestion boxes (SBs) were the most frequently cited PFS, but there were widespread concerns and disagreements among participants about their accessibility and effectiveness. Despite the providers (nurses) and administrators describing SBs as widely available, they stated that they had not received feedback or complaints from patients for a very long time. In contrast, most patients stated that SBs were either unavailable or ineffective in many facilities, with concerns about non-user friendliness and lack of responsiveness as the main issues when discussing effectiveness. Conclusion: Despite the many benefits of PFS in improving healthcare service quality, their availability, user-friendliness, and responsiveness still pose challenges. A call is made to providers, health administrators and researchers to prioritize the PFS as both a useful entry point to reducing tensions in therapeutic relationships and, a tool for improving patient service uptake, continuity of care and satisfaction. [ABSTRACT FROM AUTHOR]

Background: Interorganizational networks in healthcare do not always attain their goals. Existing models outline the factors that could explain poor network performance: governance; structure; and the alignment of professional, organizational and network levels. However, these models are very generic and assume a functional approach. We investigate available empirical knowledge on how network structure and governance relate to each other and to network performance in a multilevel context, to get deeper insight, supported with empirics, of why networks (fail to) achieve their goals.Method: A systematic literature review based on a search of Web of Science, Business Source Complete and PubMed was executed in May 2021 and repeated in January 2022. Full papers were included if they were written in English and reported empirical data in a healthcare interorganizational setting. Included papers were coded for the topics of governance, structure, performance and multilevel networks. Papers from the scientific fields of management, administration and healthcare were compared. Document citation and bibliographic coupling networks were visualized using Vosviewer, and network measures were calculated with UCINET.Results: Overall, 184 papers were included in the review, most of which were from healthcare journals. Research in healthcare journals is primarily interested in the quality of care, while research in management and administration journals tend to focus on efficiency and financial aspects. Cross-citation is limited across different fields. Networks with a brokered form of governance are the most prevalent. Network performance is mostly measured at the community level. Only a few studies employed a multilevel perspective, and interaction effects were not usually measured between levels.Conclusions: Research on healthcare networks is fragmented across different scientific fields. The current review revealed a range of positive, negative and mixed effects and points to the need for more empirical research to identify the underlying reasons for these outcomes. Hardly any empirical research is available on the effects of different network structures and governance modes on healthcare network performance at different levels. We find a need for more empirical research to study healthcare networks at multiple levels while acknowledging hybrid governance models that may apply across different levels. [ABSTRACT FROM AUTHOR]

Background: Governments, funders and hospital managers around the world are looking for ways to address the continual growth in expenditure by reducing the level of waste in the healthcare delivery system and improving the value of care provided to patients. Process improvement methods are applied to increase high value care, reduce low value care and remove waste from care processes. The purpose of this study is to review the literature to identify the methods used by hospitals to measure and capture financial benefits from PI initiatives to identify best practice. The review also pursues the way hospitals collate these benefits at the enterprise level to achieve improved financial performance. Methods: A systematic review was undertaken in line with the PRISMA process and employed qualitative research methods. Databases searched were Medline, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science and SCOPUS. The initial search was conducted in in July 2021 with a follow up search conducted in February 2023 using the same search terms and databases to identify additional studies published in the intervening period. The search terms were identified through the PICO (Participants, Interventions, Comparisons and Outcomes) method. Results: Seven papers were identified that reported reduction in care process waste or improvement of the value of care using an evidence-based PI approach and included financial benefits analysis. Positive financial impact was measured for the PI initiatives but none of the studies reported how these financial benefits were captured or applied at the enterprise level. Three of the studies suggested that sophisticated cost accounting systems were required to enable this. Conclusion: The study demonstrates the paucity of literature in the field of PI and financial benefits measurement in healthcare. Where financial benefits are documented, they vary in terms of cost inclusions and the ‘level’ at which the costs were measured. Further research on best practice financial measurement methods is needed to enable other hospitals to measure and capture financial benefits arising from their PI programs. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the h-index, and subsequently the research productivity, among different ophthalmic subspecialties in the United States.Methods: A cohort of over 15,000 academic ophthalmologists residing in the United States (US) was identified out of the physician list of the American Academy of Ophthalmology. Of them, 1000 ophthalmologists with at least one publication were randomly retrieved, 100 in each of the following 10 subspecialties: cataract, cornea/external disease, glaucoma, medical retina, neuro-ophthalmology, pediatric ophthalmology, plastic/reconstructive ophthalmology, refractive surgery, retina/vitreous surgery and uveitis. Data collected included: number of published papers, h-index score, annual increase in h-index and the mean number of authors on each paper.Results: The mean h-index amongst all subspecialties was 9.87 ± 13.90, and the mean average annual increase in h-index was 0.22 ± 0.21. The mean number of papers published was 37.20 ± 80.08 and the mean number of authors on each paper was 3.39 ± 0.84. Uveitis was the most prolific subspecialty in mean number of papers (74.78 ± 131.37), in mean h-index (16.69 ± 20.00) and in mean annual increase in h-index (0.35 ± 0.28). The least fertile subspecialty with regards to research was cataract with 11.06 ± 27.65 mean number of papers, a mean h-index of 3.89 ± 5.84, and a mean annual increase in h-index of 0.11 ± 0.11.Conclusions: This study describes the research productivity in each ophthalmic subspecialty in the US, thus providing information on the research performance of each field and on the expected academic accomplishments within it. [ABSTRACT FROM AUTHOR]

Background: The National Health Service Diabetes Prevention Programme (NHS DPP) was commissioned by NHS England in 2016 and rolled out in three 'waves' across the whole of England. It aims to help people with raised blood glucose levels reduce their risk of developing type 2 diabetes through behaviour change techniques (e.g., weight loss, dietary changes and exercise). An independent, longitudinal, mixed methods evaluation of the NHS DPP was undertaken. We report the findings from the implementation work package: a qualitative interview study with designated local leads, responsible for the local commissioning and implementation of the programme. The aim of the study was to explore how local implementation processes were enacted and adapted over time. Methods: We conducted a telephone interview study across two time-points. Twenty-four semi-structured interviews with local leads across 19 sampled case sites were undertaken between October 2019 and January 2020 and 13 interviews with local leads across 13 sampled case sites were conducted between July 2020 and August 2020. Interviews aimed to reflect on the experience of implementation and explore how things changed over time. Results: We identified four overarching themes to show how implementation was locally enacted and adapted across the sampled case sites: 1. Adapting to provider change; 2. Identification and referral; 3. Enhancing uptake in underserved populations; and 4. Digital and remote service options. Conclusion: This paper reports how designated local leads, responsible for local implementation of the NHS DPP, adapted implementation efforts over the course of a changing national diabetes prevention programme, including how local leads adapted implementation during the COVID-19 pandemic. This paper highlights three main factors that influence implementation: the importance of facilitation, the ability (or not) to tailor interventions to local needs and the role of context in implementation. [ABSTRACT FROM AUTHOR]

Background: Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. Methodology: A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. Results: A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. Conclusion: High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research. [ABSTRACT FROM AUTHOR]

Background: Based on the Chinese model of medical-elderly care integration, this paper aims to explore the impact of different investment levels on the performance of the medical-elderly care integrated institutions.Methods: Using the method of system dynamics, this paper establishes the performance evaluation model of medical-elderly care integrated institutions, sets the system element input, service level, and policy support as the key factors, and uses Vensim PLE software for simulation.Results: The three key factors have different degrees of positive impact on the performance of medical-elderly care integrated institutions. On the whole, policy support has the most significant impact on the performance of institutions, followed by the level of medical-elderly care integrated services. Institutional input mainly has a great impact on the performance of institutions in the early stage. In addition, the model simulation results also show the emergence effect: the improvement rate of institutional performance under the comprehensive simulation is higher than the sum of the improvement rates under the separate action of single factor.Conclusion: Government policies have played an important role in promoting the development of medical-elderly care integrated institutions. The service level and resource input can effectively promote the performance of medical-elderly care integrated institutions. Institutions should formulate development strategies from a systematic perspective, and pay attention to the integration of "medical" and "elderly care" resources. [ABSTRACT FROM AUTHOR]

Background: This paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023. Methods: This upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops. Discussion: This protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other's resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings. [ABSTRACT FROM AUTHOR]

Background: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic. Methods: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet's first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT. Results: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist's management decision, based on final recommendations undertaken 11-months post data collection. Conclusions: Physiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction. Key points: 1. This is the first study investigating interprofessional agreement between physiotherapists and an ENT medical practitioner in the diagnosis and management of patients within an ENT primary contact physiotherapy-led vestibular clinic (recommendations were based on a vestibular physiotherapy assessment as participants were not directly assessed by ENT). 2. Physiotherapists and ENT agreement on diagnosis was substantial. 3. Agreement between physiotherapy and ENT on requesting MRI brain and CT head were near perfect; and agreement between physiotherapy and ENT for onward management to ENT, neurology or physiotherapy was moderate to near perfect. 4. There were no adverse events from physiotherapy's management decision, based on the final recommendations. 5. This paper provides support for the competency of physiotherapists in managing patients referred to ENT with vestibular dysfunction and the safety of ENT primary contact physiotherapy-led vestibular clinics, albeit the presence of bias given the recommendations were based on a vestibular physiotherapy assessment only. [ABSTRACT FROM AUTHOR]

Background: Decision models are increasingly used to inform policy-making processes, and there is a need to improve their credibility. The estimation of health and economic outcomes generated from decision models is influenced by the development process itself. This paper aims to present the conceptual model development process of cardiometabolic disease (CMD) policy models in the UK setting. Methods: This conceptual model followed the International Society of Pharmacoeconomics and Outcomes Research-Society of Medical Decision Making (ISPOR-SMDM) Modelling Good Research Practices Task Force-2. Results: First, for the conceptualisation of the problem, the CMD disease staging, progression and current clinical guidelines were summarised, followed by a systematic review of published policy models. We critically appraised policy models such as cardiovascular disease and type 2 diabetes. Key messages from the review emphasised the importance of understanding various determinants influencing model development, including risk factors, model structure, models' parameters, data utilisation, economic perspective, equality/equity consideration, transparency and validation process. Second, as a sequential process, is model conceptualisation, to determine which modelling types and their attributes best represent the defined problem. Expert opinions, including a clinician and experienced modellers, provided input on the state transition model to ensure the structure is clinically relevant. From this stage, the consideration and agreement to establish a disease state in a state transition model was discussed. Conclusion: This conceptual model serves as a basis for representing the systematic process for structuring a CMD policy model to enhance its transparency and credibility. [ABSTRACT FROM AUTHOR]

Background: Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability. Methods: Using a mixed-methods approach, and adapting Siddiqi's framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance. Results: The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns. Discussion: The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG's role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG's sustainability and integration into national programs. Conclusion: The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program's success and sustainability. Key message: • A hybrid governance model that combines top-down and bottom-up approaches effectively improves immunisation programs in conflict settings and promotes local ownership. • In conflict settings, immunisation programmes require strong and direct intervention from the WHO with central management and coordination of the vaccine activities. • In conflict areas, when the government is a party to the conflict or has limited access to some areas, United Nations institutions must intervene to manage or support vaccine activities in partnership with local entities, regardless of notions of national sovereignty. • In Syria, the reluctance of United Nations institutions to fill the void left by the state in areas outside its control and provide vaccines led to the emergence of many diseases, including polio in 2013 and measles in 2017. [ABSTRACT FROM AUTHOR]

Background: The care of wounds is an ongoing issue for Indigenous people worldwide, yet culturally safe Indigenous wound care training programs for rural and remote Australian Aboriginal Health Workers are largely unavailable. The higher prevalence of chronic disease, lower socioeconomic status and poorer access to services experienced by Aboriginal and Torres Strait Islanders compared to non-Indigenous people, leads to a greater incidence of chronic wounds in Aboriginal and Torres Strait Islander people. Identifying the barriers and enablers for delivering wound care will establish areas of need for facilitating the development of a specific wound care program for Aboriginal Health Workers and Aboriginal Health Practitioners. This paper reports the first phase of a larger project directly aligned to the Indigenous Australians’ Health Program’s objective of supporting the delivery and access to high quality, culturally appropriate health care and services to Aboriginal and Torres Strait Islander Australians. This study aimed to examine experiences of Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses for managing chronic wounds within rural and remote Aboriginal Medical Services in Queensland, Australia. Methods: Yarning facilitated by two Aboriginal researchers among Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses currently employed within four Aboriginal Medical Services located in rural and remote areas of Queensland, Australia. Results: Two themes were developed through rigorous data analysis of yarning information and responses: participants’ experiences of managing wounds and barriers and enablers to effective wound care. Conclusions: This study contributes an insight into the experiences of Aboriginal Health Workers on the current barriers and enablers to timely treatment of chronic wounds. Results from this study indicate a significant barrier to obtaining timely and effective wound care in regional and remote settings is access to an appropriately skilled, culturally competent, and resourced health work force. A lack of education and professional development for Aboriginal Health Workers can compromise their ability to maximise patient outcomes and delay wound healing. Findings have informed the development of an evidence based, culturally competent open access chronic wound care education program for Aboriginal Health Workers. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship (AMS) aims to improve antibiotic use while reducing resistance and its consequences. There is a paucity of data on the availability of AMS programmes in southern Nigeria. Further, there is no data on Nigerian healthcare professionals' knowledge of the WHO 'Access, Watch and Reserve' (AWaRe) classification of antibiotics. This study sought to assess knowledge of AMS and the AWaRe classification of antibiotics among frontline healthcare professionals in Akwa Ibom State, Nigeria. Methods: This was a cross-sectional survey of 417 healthcare professionals, comprising medical doctors, pharmacists and nurses, across 17 public hospitals in Akwa Ibom State, Nigeria. A paper-based self-completion questionnaire was used to collect data from the participants during working hours between September and November 2023. Statistical analysis was done using SPSS version 25.0, with p < 0.05 indicating statistical significance. Results: Four hundred and seventeen out of the 500 healthcare professionals approached agreed to participate, giving an 83.4% response rate. Most of the participants were female (62.1%) and nurses (46.3%). Approximately 57% of participants were familiar with the term antibiotic/antimicrobial stewardship, however, only 46.5% selected the correct description of AMS. Majority (53.0%) did not know if AMS programme was available in their hospitals. 79% of participants did not know about AWaRe classification of antibiotics. Among the 87 (20.9%) who knew, 28.7% correctly identified antibiotics into the AWaRe groups from a given list. Only profession significantly predicted knowledge of AMS and awareness of the AWaRe classification of antibiotics (p < 0.001). Pharmacists were more likely to define AMS correctly than medical doctors (odds ratio [OR] = 2.02, 95% confidence interval [CI] = 1.16–3.52, p = 0.012), whereas nurses were less likely to be aware of the WHO AWaRe classification of antibiotics than medical doctors (OR = 0.36, 95% CI = 0.18–0.72, p = 0.004). Conclusions: There was a notable knowledge deficit in both AMS and the AWaRe classification of antibiotics among participants in this study. This highlights the need for educational interventions targeted at the different cadres of healthcare professionals on the role of AMS programmes in reducing antimicrobial resistance and its consequences. [ABSTRACT FROM AUTHOR]

Background: Stroke is a leading cause of mortality and disability. In higher-income countries, mortality and disability have been reduced with advances in stroke care and early access to rehabilitation services. However, access to such services and the subsequent impact on stroke outcomes in the Philippines, which is a lower- and middle-income countries (LMIC), is unclear. Understanding gaps in service delivery and underpinning research from acute to chronic stages post-stroke will allow future targeting of resources. Aims: This scoping review aimed to map available literature on stroke services in the Philippines, based on Arksey and O'Malley's five-stage-process. Summary of review: A targeted strategy was used to search relevant databases (Focused: MEDLINE (ovid), EMBASE (ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO (ebsco); broad-based: Scopus; review-based: Cochrane Library, International Prospective Register of Systematic Reviews (PROSPERO), JBI (formerly Joanna Briggs Institute) as well as grey literature (Open Grey, Google scholar). The searches were conducted between 12/2022-01/2023 and repeated 12/2023. Literature describing adults with stroke in the Philippines and stroke services that aimed to maximize well-being, participation and function were searched. Studies were selected if they included one or more of: (a) patient numbers and stroke characteristics (b) staff numbers, qualifications and role (c) service resources (e.g., access to a rehabilitation unit) (d) cost of services and methods of payment) (e) content of stroke care (f) duration of stroke care/rehabilitation and interventions undertaken (g) outcome measures used in clinical practice. A total of 70 papers were included. Articles were assessed, data extracted and classified according to structure, process, or outcome related information. Advances in stroke services, including stroke ready hospitals providing early access to acute care such as thrombectomy and thrombolysis and early referral to rehabilitation coupled with rehabilitation guidelines have been developed. Gaps exist in stroke services structure (e.g., low number of neurologists and neuroimaging, lack of stroke protocols and pathways, inequity of stroke care across urban and rural locations), processes (e.g., delayed arrival to hospital, lack of stroke training among health workers, low awareness of stroke among public and non-stroke care workers, inequitable access to rehabilitation both hospital and community) and outcomes (e.g., low government insurance coverage resulting in high out-of-pocket expenses, limited data on caregiver burden, absence of unified national stroke registry to determine prevalence, incidence and burden of stroke). Potential solutions such as increasing stroke knowledge and awareness, use of mobile stroke units, TeleMedicine, TeleRehab, improving access to rehabilitation, upgrading PhilHealth and a unified national long-term stroke registry representing the real situation across urban and rural were identified. Conclusion: This scoping review describes the existing evidence-base relating to structure, processes and outcomes of stroke services for adults within the Philippines. Developments in stroke services have been identified however, a wide gap exists between the availability of stroke services and the high burden of stroke in the Philippines. Strategies are critical to address the identified gaps as a precursor to improving stroke outcomes and reducing burden. Potential solutions identified within the review will require healthcare government and policymakers to focus on stroke awareness programs, primary and secondary stroke prevention, establishing and monitoring of stroke protocols and pathways, sustainable national stroke registry, and improve access to and availability of rehabilitation both hospital and community. What is already known?: Stroke services in the Philippines are inequitable, for example, urban versus rural due to the geography of the Philippines, location of acute stroke ready hospitals and stroke rehabilitation units, limited transport options, and low government healthcare insurance coverage resulting in high out-of-pocket costs for stroke survivors and their families. What are the new findings?: The Philippines have a higher incidence of stroke in younger adults than other LMICs, which impacts the available workforce and the country's economy. There is a lack of data on community stroke rehabilitation provision, the content and intensity of stroke rehabilitation being delivered and the role and knowledge/skills of those delivering stroke rehabilitation, unmet needs of stroke survivors and caregiver burden and strain, What do the new findings imply?: A wide gap exists between the availability of stroke services and the high burden of stroke. The impact of this is unclear due to the lack of a compulsory national stroke registry as well as published data on community or home-based stroke services that are not captured/published. What does this review offer?: This review provides a broad overview of existing evidence-base of stroke services in the Philippines. It provides a catalyst for a) healthcare government to address stroke inequities and burden; b) development of future evidence-based interventions such as community-based rehabilitation; c) task-shifting e.g., training non-neurologists, barangay workers and caregivers; d) use of digital technologies and innovations e.g., stroke TeleRehab, TeleMedicine, mobile stroke units. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare waste is any waste generated by healthcare facilities that is considered potentially hazardous to health. Solid healthcare waste is categorized into infectious and non-infectious wastes. Infectious waste is material suspected of containing pathogens and potentially causing disease. Non-infectious waste includes wastes that have not been in contact with infectious agents, hazardous chemicals, or radioactive substances, similar to household waste, i.e. plastic, papers and leftover foods. This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia. The setting was all health facilities found in Hossaena town. Method: A mixed-method study design was used. For the qualitative phase of this study, eight FGDs were conducted from 4 government health facilities, one FGD from each private health facility (which is 37 in number), and forty-five FGDs were conducted. Four FGDs were executed with cleaners; another four were only health care providers because using homogeneous groups promotes discussion. The remaining 37 FGDs in private health facilities were mixed from health professionals and cleaners because of the number of workers in the private facilities. For the quantitative phase, all health facilities and health facility workers who have direct contact with healthcare waste management practice participated in this study. Both qualitative and quantitative study participants were taken from the health facilities found in Hossaena town. Result: Seventeen (3.1%) health facility workers have hand washing facilities. Three hundred ninety-two (72.6%) of the participants agree on the availability of one or more personal protective equipment (PPE) in the facility "the reason for the absence of some of the PPEs, like boots and goggles, and the shortage of disposable gloves owes to cost inflation from time to time and sometimes absent from the market". The observational finding shows that colour-coded waste bins are available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. Two hundred seventy-one (50.2%) of the respondents were satisfied or agreed that satisfactory procedures are available in case of an accident. Only 220 (40.8%) respondents were vaccinated for the Hepatitis B virus. Conclusion: Hand washing facilities, personal protective equipment and preventive vaccinations are not readily available for health workers. Solid waste segregation practices are poor and showed that solid waste management practices (SWMP) are below the acceptable level. [ABSTRACT FROM AUTHOR]

Background: Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings. Methods: We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis. Results: The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy. Conclusion: This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes. [ABSTRACT FROM AUTHOR]

Background: The Stop Cancer PAIN Trial was a phase III pragmatic stepped wedge cluster randomised controlled trial which compared effectiveness of screening and guidelines with or without implementation strategies for improving pain in adults with cancer attending six Australian outpatient comprehensive cancer centres (n = 688). A system for pain screening was introduced before observation of a 'control' phase. Implementation strategies introduced in the 'intervention' phase included: (1) audit of adherence to guideline recommendations, with feedback to clinical teams; (2) health professional education via an email-administered 'spaced education' module; and (3) a patient education booklet and self-management resource. Selection of strategies was informed by the Capability, Opportunity and Motivation Behaviour (COM-B) Model (Michie et al., 2011) and evidence for each strategy's stand-alone effectiveness. A consultant physician at each centre supported the intervention as a 'clinical champion'. However, fidelity to the intervention was limited, and the Trial did not demonstrate effectiveness. This paper reports a sub-study of the Trial which aimed to identify factors inhibiting or enabling fidelity to inform future guideline implementation initiatives. Methods: The qualitative sub-study enabled in-depth exploration of factors from the perspectives of personnel at each centre. Clinical champions, clinicians and clinic receptionists were invited to participate in semi-structured interviews. Analysis used a framework method and a largely deductive approach based on the COM-B Model. Results: Twenty-four people participated, including 15 physicians, 8 nurses and 1 clinic receptionist. Coding against the COM-B Model identified 'capability' to be the most influential component, with 'opportunity' and 'motivation' playing largely subsidiary roles. Findings suggest that fidelity could have been improved by: considering the readiness for change of each clinical setting; better articulating the intervention's value proposition; defining clinician roles and responsibilities, addressing perceptions that pain care falls beyond oncology clinicians' scopes of practice; integrating the intervention within existing systems and processes; promoting patient-clinician partnerships; investing in clinical champions among senior nursing and junior medical personnel, supported by medical leaders; and planning for slow incremental change rather than rapid uptake. Conclusions: Future guideline implementation interventions may require a 'meta-implementation' approach based on complex systems theory to successfully integrate multiple strategies. Trial registration: Registry: Australian New Zealand Clinical Trials Registry; number: ACTRN 12615000064505; data: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=367236&isReview=true. [ABSTRACT FROM AUTHOR]

Introduction: The significance of Primary Healthcare Centers (PHCCs) in fostering health equity and enhancing health outcomes cannot be overstated, especially in low and middle-income countries. This paper's primary area of interest is to create evidence and innovation for PHCs, with a particular emphasis on underserved groups. Thus, the study aimed to investigate the state of primary health care in Nigeria, with a particular emphasis on best practices, challenges to best practices, and quality of care. Methodology: A cross-sectional quantitative study was conducted to collect secondary data from 29 primary healthcare facilities. The data was collected using staff and facility activity indicators over a year (2022). Descriptive statistics and chi-square tests were used to analyze the collected data. Result: Our study data showed that all of the PHCCs have service rosters that can be utilized for follow-up with patients. About 85 (84.1%) respondents have reported that deliveries were taken by the reporting midwife, and 55 (54.5%) respondents indicated that their facilities provided on-the-job training to their staff. This is considered as the best practice in the facility. However, the majority of the PHCCs (71.3%) lacked assessment teams, which was found to have a negative impact on the quality of healthcare provided at these facilities (p < 0.05). Conclusion: Our study underscores the pressing need for primary healthcare services in Nigeria. Government authorities and healthcare providers must take action to overcome the challenges of limited capacity, service delivery, and quality of care. By adopting effective strategies and ensuring access to primary healthcare, citizens' health outcomes can be greatly enhanced. Thus, it is essential to revamp and optimize healthcare facilities to establish an efficient healthcare system that caters to the needs of all citizens. [ABSTRACT FROM AUTHOR]

Background: Upper gastrointestinal cancers (UGICs) are increasingly prevalent. With a poor prognosis and significant longer-term effects, UGICs present significant adjustment challenges for individuals with cancer and their informal caregivers. However, the supportive care needs of these informal caregivers are largely unknown. This systematic review of qualitative studies synthesises and critically evaluates the current evidence base on the experience of informal caregivers of individuals with UGIC. Methods: A Joanna Briggs Institute systematic review was conducted. Searches were performed in four databases (MEDLINE, PsycINFO, Embase, CINAHL) from database inception to February 2021. Included studies explored experiences of informal caregivers of individuals diagnosed with primary cancer of the oesophagus, stomach, pancreas, bile duct, gallbladder, or liver. Studies were independently screened for eligibility and included studies were appraised for quality by two reviewers. Data were extracted and synthesised using meta-aggregation. Results: 19 papers were included in this review, and 328 findings were extracted. These were aggregated into 16 categories across three findings: (1) UGIC caregiver burden; UGIC caregivers undertake extensive responsibilities, especially around patient diet as digestion is severely impacted by UGICs. (2) Mediators of caregiver burden; The nature of UGICs, characterised by disruptive life changes for caregivers, was identified as a mediator for caregiver burden. (3) Consequences of caregiver burden: UGIC caregivers' experiences were shaped by unmet needs, a lack of information and a general decline in social interaction. Conclusions: The findings of this review suggest the need for a cultural shift within health services. Caregiving for UGIC patients is suggested to adversely affect caregivers' quality of life, similarly to other cancer caregiving populations and therefore they should be better incorporated as co-clients in care-planning and execution by including them in discussions about the patient's diagnosis, treatment options, and potential side effects. [ABSTRACT FROM AUTHOR]

Background: The healthcare system is under tremendous pressure. One possible solution towards relieving some of this pressure is to use Positive Health, which takes 'health' as a starting point, rather than 'illness'. Positive Health provides opportunities for stimulating integrated care. Methods: Three cases in the Netherlands are studied in this paper. Their way of working with Positive Health is investigated through semi-structured and narrative interviews, using realist-evaluation and thematic analyses. Results: Seven 'working elements' are identified that enhance the chances of successfully implementing Positive Health in practice (part 1). The interviews show that healthcare professionals have noticed that people adopt a healthier lifestyle and gain a greater degree of control over their own health. This boosts job satisfaction for healthcare professionals too. The organisations and professionals involved are enthusiastic about working with Positive Health, but still experience barriers (part 2). Conclusions: The results of this study imply that implementing Positive Health in practice can facilitate collaboration between organisations and professionals from different disciplines, such as healthcare, welfare, and municipal health services. Operating from the perspective of a shared goal, professionals from different disciplines will find it easier to jointly organise activities to foster citizens' health. Additionally, more attention is paid to non-medical problems affecting people's well-being, such as loneliness or financial problems. [ABSTRACT FROM AUTHOR]

Background: Governments worldwide are facing growing pressure to increase transparency, as citizens demand greater insight into decision-making processes and public spending. An example is the release of open healthcare data to researchers, as healthcare is one of the top economic sectors. Significant information systems development and computational experimentation are required to extract meaning and value from these datasets. We use a large open health dataset provided by the New York State Statewide Planning and Research Cooperative System (SPARCS) containing 2.3 million de-identified patient records. One of the fields in these records is a patient's length of stay (LoS) in a hospital, which is crucial in estimating healthcare costs and planning hospital capacity for future needs. Hence it would be very beneficial for hospitals to be able to predict the LoS early. The area of machine learning offers a potential solution, which is the focus of the current paper. Methods: We investigated multiple machine learning techniques including feature engineering, regression, and classification trees to predict the length of stay (LoS) of all the hospital procedures currently available in the dataset. Whereas many researchers focus on LoS prediction for a specific disease, a unique feature of our model is its ability to simultaneously handle 285 diagnosis codes from the Clinical Classification System (CCS). We focused on the interpretability and explainability of input features and the resulting models. We developed separate models for newborns and non-newborns. Results: The study yields promising results, demonstrating the effectiveness of machine learning in predicting LoS. The best R2 scores achieved are noteworthy: 0.82 for newborns using linear regression and 0.43 for non-newborns using catboost regression. Focusing on cardiovascular disease refines the predictive capability, achieving an improved R2 score of 0.62. The models not only demonstrate high performance but also provide understandable insights. For instance, birth-weight is employed for predicting LoS in newborns, while diagnostic-related group classification proves valuable for non-newborns. Conclusion: Our study showcases the practical utility of machine learning models in predicting LoS during patient admittance. The emphasis on interpretability ensures that the models can be easily comprehended and replicated by other researchers. Healthcare stakeholders, including providers, administrators, and patients, stand to benefit significantly. The findings offer valuable insights for cost estimation and capacity planning, contributing to the overall enhancement of healthcare management and delivery. [ABSTRACT FROM AUTHOR]

Background: High-cost medical consumables (HMCs) have emerged as significant economic and technological challenges for numerous national healthcare systems. Governmental hospitals play an indispensable role in many national health systems, closely linked to the evaluation of admissions and the management of procurement for HMCs. Nevertheless, many governmental hospitals face avoidable management risks due to the lack of a decision-making tool. In response, we conducted a systematic review to establishing a framework for the admission criteria of HMCs. This framework aims to enhance their effective utilization and maximize economic, clinical, and social benefits. Methods: In accordance with a systematic review protocol developed for our study, we conducted comprehensive searches in the PubMed, Web of Science, and Embase databases to identify all correlation studies conducted prior to December 31, 2021. Subsequently, two independent reviewers performed a two-round screening process, resulting in the inclusion of 23 articles in our study. Finally, a third reviewer meticulously examined the selected indicators and contributed to the development of the final criterion framework. Results: The criterion framework was established with 7 first-level indicators and 23 s-level indicators. Among the first-level indicators, "Clinical Benefit" held the highest significance, with a combined weight of 1.606, followed by "Economic Value" and "Organizational Impact" at 1.497 and 1.159, respectively. At the second level, "Safety" and "Efficacy" carried equal weight in the decision-making tool, with combined weights of approximately 1.300 each and a standard combined weight of 0.130. Conclusion: This admission criteria framework serves as a vital decision-making tool for managing admissions and highlights several crucial evaluation indicators. Economic considerations emerge as the principal determinant in HMCs procurement decisions. Consequently, healthcare managers and decision-makers are recommended to give precedence to value-based healthcare and evidence-based procurement practices. In the long term, governmental hospitals must grapple with the challenge of judiciously allocating limited resources to maximize both social and economic benefits. [ABSTRACT FROM AUTHOR]

Background: Electronic medical record (EMR) systems provide timely access to clinical information and have been shown to improve medication safety. However, EMRs can also create opportunities for error, including system-related errors or errors that were unlikely or not possible with the use of paper medication charts. This study aimed to determine the detection and mitigation strategies adopted by a health district in Australia to target system-related errors and to explore stakeholder views on strategies needed to curb future system-related errors from emerging. Methods: A qualitative descriptive study design was used comprising semi-structured interviews. Data were collected from three hospitals within a health district in Sydney, Australia, between September 2020 and May 2021. Interviews were conducted with EMR users and other key stakeholders (e.g. clinical informatics team members). Participants were asked to reflect on how system-related errors changed over time, and to describe approaches taken by their organisation to detect and mitigate these errors. Thematic analysis was conducted iteratively using a general inductive approach, where codes were assigned as themes emerged from the data. Results: Interviews were conducted with 25 stakeholders. Participants reported that most system-related errors were detected by front-line clinicians. Following error detection, clinicians either reported system-related errors directly to the clinical informatics team or submitted reports to the incident information management system. System-related errors were also reported to be detected via reports run within the EMR, or during organisational processes such as incident investigations or system enhancement projects. EMR redesign was the main approach described by participants for mitigating system-related errors, however other strategies, like regular user education and minimising the use of hybrid systems, were also reported. Conclusions: Initial detection of system-related errors relies heavily on front-line clinicians, however other organisational strategies that are proactive and layered can improve the systemic detection, investigation, and management of errors. Together with EMR design changes, complementary error mitigation strategies, including targeted staff education, can support safe EMR use and development. [ABSTRACT FROM AUTHOR]

Background: The increased socioeconomic inequality in catastrophic health expenditure (CHE) disproportionately affects disadvantaged populations, subjecting them to financial hardships, limiting their access to healthcare, and exacerbating their vulnerability to morbidity. Objectives: This study examines changes in socioeconomic inequality related to CHE and analyzes the contributing factors responsible for these changes in Pakistan between 2010-11 and 2018-19. Methods: This paper extracted the data on out-of-pocket health expenditures from the National Health Accounts for 2009-10 and 2017-18. Sociodemographic information was gathered from the Household Integrated Economic Surveys of 2010-11 and 2018-19. CHE was calculated using budget share and the ability-to-pay approaches. To assess socioeconomic inequality in CHE in 2010-11 and 2018-19, both generalized and standard concentration indices were used, and Wagstaff inequality decomposition analysis was employed to explore the causes of socioeconomic inequality in each year. Further, an Oaxaca-type decomposition was applied to assess changes in socioeconomic inequality in CHE over time. Results: The concentration index reveals that socioeconomic inequality in CHE decreased in 2018-19 compared to 2010-11 in Pakistan. Despite the reduction in inequality, CHE was concentrated among the poor in Pakistan in 2010-11 and 2018-19. The inequality decomposition analysis revealed that wealth status was the main cause of inequality in CHE over time. The upper wealth quantiles indicated a positive contribution, whereas lower quantiles showed a negative contribution to inequality in CHE. Furthermore, urban residence contributed to pro-rich inequality, whereas employed household heads, private healthcare provider, and inpatient healthcare utilization contributed to pro-poor inequality. A noticeable decline in socioeconomic inequality in CHE was observed between 2010 and 2018. However, inequality remained predominantly concentrated among the lower socio-economic strata. Conclusion: These results underscore the need to improve the outreach of subsidized healthcare and expand social safety nets. [ABSTRACT FROM AUTHOR]

Background: Limited access to specialist medical services is a major barrier to healthcare in rural areas. We compared rural-urban specialist doctor consultations outside hospital by older adults (≥ 60 years) across South Australia. Methods: Cross-sectional data were available from the South Australia's Department of Health. The Modified Monash Model (MM1-7) of remoteness was used to categorize data into rural (MM 3–4), remote (MM5-7), and urban (MM1-MM2) of participants in urban and non-urban South Australia. The analysis was conducted on older adults (n = 20,522), self-reporting chronic physical and common mental health conditions. Results: Specialist doctor consultation in the past 4 weeks was 14.6% in our sample. In multivariable analysis, increasing age (odds ratio 1.3, 95% CI: 1.2-1.4), higher education (odds ratio 1.5, 95% CI: 1.3-1.9), physical health conditions [diabetes (odds ratio 1.2, 95% CI: 1.1-1.3); cancer (odds ratio1.8, 95% CI: 1.7-2.0); heart disease (odds ratio 1.9, 95% CI: 1.6-2.1)], and common mental disorders [depression (odds ratio 1.3, 95% CI: 1.1-1.5); anxiety (odds ratio 1.4, 95% CI: 1.1-1.6)] were associated with higher specialist care use. Specialist care use among rural (odds ratio 0.8, 95% CI: 0.6–0.9), and remote (odds ratio 0.8, 95% CI: 0.7–0.9) older people was significantly lower than their urban counterparts after controlling for age, education, and chronic disease. Conclusion: Our findings demonstrate a disparity in the use of out of hospital specialist medical services between urban and non-urban areas. What is already known • Specialist care is crucial in chronic disease management • Ageing is associated with higher care needs, including specialty care • There is limited evidence relating to factors associated with specialist services use in old age What this paper adds • This study demonstrates a disparity in the use of specialty services between urban and rural environments • Beside availability of specialty services, socioeconomic factors are associated with specialist care visits Application of study findings: • Interprofessional care coordination could be a vital resource in chronic health management • Appropriate specialty care provision and use in rural areas could help reduce the rural-urban health disparities. [ABSTRACT FROM AUTHOR]

Background: This study aims to identify policy content challenges related to high-risk sexual behaviors, stimulant drugs, and alcohol consumption in Iranian adolescents. Methods: This qualitative study analyzed high-level and national documents pertaining to adolescent health, high-risk sexual behaviors, stimulant, and alcohol consumption in adolescents. The documents, which were published by public organizations between January 1979 and February 2023 and publicly available, were complemented by interviews with policymakers and executives. The study involved reviewing 51 papers and conducting interviews with 49 policymakers and executives at the national, provincial, and local levels who were involved in addressing adolescent behaviors related to high-risk sexual behaviors, stimulant, and alcohol consumption. The data collected was analyzed using conventional content analysis. Results: The study's results involved examining policy content and identifying challenges related to policy content. The analysis revealed that from the beginning of the Iranian revolution in 1979 until the late 1990s, the dominant approach in Iran was to deny the existence of high-risk behaviors among adolescents. However, in the early 2000s, the country began to adopt a new approach that acknowledged the social harms and ineffectiveness of previous strategies. As a result, a new policy framework was introduced to address high-risk behaviors among adolescents. The study's interviews with policymakers and executives identified 12 challenges related to policy content, including parallel programs, lack of institutional mapping, lack of evidence-based policymaking, lack of integrated approach regarding training, late parent training, lack of consideration of all occurrence reasons in adolescents' high-risk behaviors policymaking, and the existence of many abstinence policies regarding high-risk behaviors. Conclusions: The study's findings suggest that high-risk behaviors among adolescents in Iran are primarily a health issue, rather than a social or ideological one. Unfortunately, ideological approaches, stigma, and policymaking based on anecdotes rather than evidence have had a significant impact on this area. To improve policymaking in this domain, it is crucial to address these challenges by tackling stigma, adopting an integrated and holistic approach, and implementing evidence-based policies that consider all relevant aspects, including adolescents' subcultures and policy audiences. Such an approach can also be useful for other countries facing similar conditions. [ABSTRACT FROM AUTHOR]